Approach

Introduction

Children with fetal alcohol spectrum disorder (FASD) have a wide range of medical, developmental, behavioural, and learning difficulties. Each child is unique in their presentation; therefore, there is no 'magic bullet' for treating affected children and no curative treatment.

Systematic reviews highlight the paucity of good-quality, adequately powered, randomised controlled trials assessing interventions in FASD.[69][70]​ Treatment depends entirely on the specific needs of the child.

Individual assessment

It is likely that many children with FASD are never formally diagnosed. Thus, the first step in management requires recognition of alcohol-exposed children, diagnosis, and full clinical and psychological assessment to determine the child's specific strengths and needs. Interventions should therefore be recommended to address the child's specific profile of strengths and vulnerabilities.

Academic or learning difficulties

A variety of strategies are recommended for children with academic or learning difficulties. Cognitive control therapy (which addresses body position, movement, and awareness; attention; and information processing, controlling, and categorising) has been found to lead to improved behaviour in children with fetal alcohol syndrome (FAS).[71]

A language and literacy intervention (i.e., a combination of language therapy, phonological awareness, and literacy training administered by a speech therapist) has been shown to significantly improve literacy, reading, and spelling skills.[72][73]

A mathematics intervention has been shown to improve mathematics knowledge, which was maintained at 6-month follow-up, in children with FAS or partial FAS and an IQ over 50.[74][75] Pre- and post-test assessment in these children also suggested an improvement in behaviour following this intervention. The mathematics intervention used was the Math Interactive Learning Experience (MILE), which is based on the theory that there are basic cognitive functions that support mathematical cognitions and that impact academic achievement and adaptive functioning skills.

Virtual-reality games have also been assessed for teaching children with FAS or partial FAS.[76] Computer-based virtual-reality games can be designed to teach children a new skill (e.g., fire safety). Children receiving the virtual-reality intervention had significantly increased knowledge, which was maintained at 1-week follow-up.[76]

Executive function

In an RCT (n=78) a group-based neurocognitive habilitation intervention improved executive function and problem-solving skills in children with FAS and alcohol-related neurodevelopmental disorder (ARND) living in foster and adoptive homes.[77]

Social skills deficits

Social skills training may be useful in children who have this type of deficits. Child friendship training, a social skills training programme based on social learning theory, has been shown to significantly improve knowledge of social skills in children with FAS, partial FAS, or ARND who have social skill deficits and a verbal IQ 70 and over. This was maintained at 3-month follow-up.[78] Parents reported improved social skills and decreased problem behaviours. However, teachers did not report any significant differences.[78]

Externalising or attention problems

Parent programmes such as the Families Moving Forward Program have been assessed in children with FASD who have externalising or attention problems and a verbal IQ 70 and over.[79] This programme uses a low-intensity model of supportive behavioural consultation lasting 9 to 11 months and has shown significant improvement in parenting self-efficacy and engagement in self-care behaviours, and a decrease in challenging and disruptive behaviours.[79]

Neurocognitive habilitation was developed as a systematic intervention for children with a diagnosis of FAS or ARND in the foster-care system.[79] The programme provides support and education for families and focuses on improving children's executive functioning, which leads to improvement in measures of executive functioning.[79]

Attention-deficit/hyperactivity disorder (ADHD)

Attention process training, a programme designed to address attention and concentration in individuals with brain injury through addressing attention processing, has been shown to significantly improve measures of sustained attention and non-verbal reasoning, but not measures of executive function, in children with both FASD and ADHD.[80]

Central nervous system stimulants should be considered in children with FASD who have symptoms of ADHD.[81] Hyperactivity-impulsivity scores significantly improved with treatment, but attention did not improve in children with a diagnosis of ADHD in addition to FAS or partial FAS.[82][83]​​​ Children with both ADHD and FASD may have a better response to dexamphetamine than methylphenidate.[84] Non-stimulants (atomoxetine, guanfacine, or clonidine) may be helpful for children with anxiety symptoms or if stimulants are not effective.​[85]​ See Attention deficit hyperactivity disorder in children.

Birth defects

Surgery may be required, the type depending on the specific birth defect.

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